Recurrent hematuria in genital ambiguity: is genital reconstruction the best option? : a diagnostic and therapeutic dilemma / Myka Janine M. Villarroya.

Contributor(s):

Villarroya, Myka Janine M., MD [author]

Language: english Publication details: Fairview, Quezon City: Department of Obstetrics and Gynecology, FEU-NRMF, 2017.Description: tables, photos; (in folder) + with flash drive (soft copy)Content type:

text

Media type:

unmediated

Carrier type:

volume

LOC classification:

OB 2017 0006

Summary: Abstract: Congenital Adrenal Hyperplasia (CAH) is an inherited autosomal recessive disease that causes virilization of the external genitalia. The deficiency of the enzyme, 21-hydroxylase will most likely have leads to genitalia. The objective of this paper is to present the dilemma in the diagnosis and management of Recurrent hematuria in patient with Genital ambiguity secondary to Congenital Adrenal Hyperplasia. This is a case of a 22 year old, female, with recurrent hematuria and Urinary Tract Infection, has genital ambiguity due to congenital hyperplasia was worked up for possible genital reconstruction. On ultrasound finding, the distal end of the vaginal canal seems to be connected to the urethra and was noted to be 1.32cm from meatus; Hamatoclpos was also noted. Is the recurrent hematuria due to cyclic menstruation of this patient? Surgical management of genital ambiguity due to congenital adrenal hyperplasia is associated with few immediate postoperative, infectious and urinary complications as well as unwanted permanent outcomes such as Vaginal stenosis and the like. The exact method of reconstruction depends on the anatomy of the patient. In our patient she had enlarged clitoris measuring 1 x 0.5 x 1 cm. However, in this patient who is reared as female, emotionally confident that she is a woman with the complaint of recurrent hematuria and UTI, will genital reconstruction improve the patient medically, psychologically and emotionally? What about the postoperative complications that may happen after the operation? These questions posed a dilemma on the surgeons on whether the restoration of anatomical, functional, cosmetic and psychosexual aspect will be the best option for this patient. Definitive plan for our case was Cliteroplasty with creation of Neovagina. However due to financial constraints patient opted for medical management.

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Item type	Current library	Call number	Status	Notes	Date due	Barcode
Room Use	Far Eastern University - Nicanor Reyes Medical Foundation Research	OB 2017 0006 (Browse shelf(Opens below))	Available	with flash drive (soft copy)		R000561

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Previous	OB20160004 Placenta Induced Third Trimester Uterine Rupture in an Unscarred Uterus: A Diagnostic Dilemma	OB 2017 0004 A Wound that failed to heal : high grade ovarian serous carcinoma associated with chronic schistosomiasis /	OB 2017 0005 Cesarean scar pregnancy "a rarity no more " a report of 2 cases /	OB 2017 0006 Recurrent hematuria in genital ambiguity: is genital reconstruction the best option? : a diagnostic and therapeutic dilemma /	OB20170001 A Comparative Study on the Maternal and Neonatal Outcomes Associated with the Use of Isoxsuprine Versus Nifedipine in the Prevention of Preterm Birth among Patients Admitted at A Tertiary Center from 2009-2013	OB20170002 Association of the Sociodemographic Factors with Pregnancy - Related Outcome Among Adolescent Pregnant Women seen at A Tertiary Hospital from 2010 to 2014	OB20170003 Comparison of the Efficacy of Metronidazole and Metronidazole Plus Probiotics Capsule in the Treatment of Bacterial Vaginosis among Non-Pregnant Patients seen at Outpatient Department of A Tertiary Hospital : A Single Blind Randomized Controlled Trial	Next

Includes appendices and bibliographical references.

Abstract: Congenital Adrenal Hyperplasia (CAH) is an inherited autosomal recessive disease that causes virilization of the external genitalia. The deficiency of the enzyme, 21-hydroxylase will most likely have leads to genitalia. The objective of this paper is to present the dilemma in the diagnosis and management of Recurrent hematuria in patient with Genital ambiguity secondary to Congenital Adrenal Hyperplasia. This is a case of a 22 year old, female, with recurrent hematuria and Urinary Tract Infection, has genital ambiguity due to congenital hyperplasia was worked up for possible genital reconstruction. On ultrasound finding, the distal end of the vaginal canal seems to be connected to the urethra and was noted to be 1.32cm from meatus; Hamatoclpos was also noted. Is the recurrent hematuria due to cyclic menstruation of this patient? Surgical management of genital ambiguity due to congenital adrenal hyperplasia is associated with few immediate postoperative, infectious and urinary complications as well as unwanted permanent outcomes such as Vaginal stenosis and the like. The exact method of reconstruction depends on the anatomy of the patient. In our patient she had enlarged clitoris measuring 1 x 0.5 x 1 cm. However, in this patient who is reared as female, emotionally confident that she is a woman with the complaint of recurrent hematuria and UTI, will genital reconstruction improve the patient medically, psychologically and emotionally? What about the postoperative complications that may happen after the operation? These questions posed a dilemma on the surgeons on whether the restoration of anatomical, functional, cosmetic and psychosexual aspect will be the best option for this patient. Definitive plan for our case was Cliteroplasty with creation of Neovagina. However due to financial constraints patient opted for medical management.

Research - Department of Obstetrics & Gynecology

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